Hepatitis B is a virus that infects the liver. It lives in liver cells and also in cells of the immune system. When the hepatitis B virus infects the liver, immune cells are attracted to the liver to help fight the infection. However, these disease-fighting cells can lead to liver inflammation.

Causes

The hepatitis B virus is passed through blood and bodily fluids and can be passed to an infant during childbirth or shortly thereafter if the mother is infected. Most newborns and about 50% of children infected with hepatitis B develop chronic hepatitis.

Symptoms

Most children with hepatitis B have no symptoms.

Exams and Tests

Blood Tests

• Hepatitis B Surface Antigen – shows that patient has hepatitis B
• Hepatitis B eAg – shows there is active viral growth
• Hepatitis B DNA – shows how much hepatitis B virus is present
• Liver enzymes (AST/ALT)
• Prothrombin time – measures the time is takes for plasma (liquid portion of blood) to clot

Note: Most children with hepatitis B have lots of virus but normal liver enzymes.

Liver Biopsy

A liver biopsy may be recommended to see how active the patient's hepatitis B is. Your child will receive sedation medications or a general anesthetic before the biopsy. These medications will prevent your child from feeling pain or anxiety or remembering the procedure. An area on the right side of your child's abdomen or upper-mid abdomen will be cleansed with an antibacterial soap. The biopsy site will then be numbed with an injection of lidocaine (numbing medicine). The pediatric GI specialist will then insert a needle through the skin and into the liver to obtain a very small piece of liver tissue. The sample will be sent to the lab to be analyzed. The doctor will apply a small pressure dressing (bandage) to the site.

After the biopsy your child will stay in or return to his/her room for four hours, when a repeat blood count is checked. (Children less than one year are observed overnight.) He or she should lie on the right side or back, depending on the biopsy site, for two hours. Being in bed will reduce the chance of bleeding after the biopsy. Once your child is awake and alert, he/she will be allowed to drink fluids. If fluids are tolerated, a regular diet can be restarted. For the remainder of the day, your child will need to participate in quiet activity. The results of the liver biopsy are usually available two weeks after the procedure.

Treatment

Most children with hepatitis B have normal liver enzymes and are not candidates for treatment initially. For children with chronic hepatitis B and elevated liver enzymes, there are two possible treatments that have been studied in children; research is ongoing.

Interferon

Interferon is a protein the body normally makes to modulate the immune system and to fight viruses. It is made in pure form in the test-tube and can be given in high doses. Treatment consists of injections of Interferon under the skin three times a week for a six-month period. This treatment has a number of side effects which can include fevers, chills and flu-like symptoms for the first few doses, and low white blood cell counts, depression and GI symptoms. This treatment is effective in reducing hepatitis B activity (the disease goes away) only about 10 percent of the time. A one-ounce/per week shot has been tested in adults.

Lamivudine

This FDA-approved drug is given daily in a pill or liquid form and treatment is continued for a year or more. It has very few serious side effects, although it can rarely cause acidosis (an excess of acid in the bloodstream) or pancreatitis (inflamed pancreas). The drug may induce the virus to mutate or change so the drug no longer works on it; this occurs as much as 40+ percent of the time, although this mutated virus does not usually appear to be very harmful. About 25 percent of treated children respond to the drug by decreasing virus activity (hepatitis B rarely clears with this treatment).

Points to Remember

• Hepatitis B is a disease of the liver caused by the hepatitis B virus, which can be passed from mother to child during childbirth.
• Approximately 50 percent of infants and children develop chronic hepatitis B, a lifelong condition.
• Children with chronic hepatitis B and elevated liver enzymes can be treated but will need to have their liver monitored regularly to check for liver damage.